Healthcare Provider Details

I. General information

NPI: 1649174483
Provider Name (Legal Business Name): HISGRACE NURSING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4148 SHORTHORN WAY
ROSEVILLE CA
95747-4204
US

IV. Provider business mailing address

4148 SHORTHORN WAY
ROSEVILLE CA
95747-4204
US

V. Phone/Fax

Practice location:
  • Phone: 916-470-4060
  • Fax:
Mailing address:
  • Phone: 916-470-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIAM SOLOME NNAMALIRI
Title or Position: CEO
Credential: NURSE PRACTITIONER
Phone: 916-470-4060